A Doula’s Guide to Preemie Care

In June of 2010 at 30 weeks of pregnancy I delivered my youngest son, Cohen, by cesarean due to severe preeclampsia, HELLP syndrome, IUGR, and absent-end diastolic flow. To put it frankly, medical complications were popping up left and right and delivery was the safest and healthiest option though quite unexpected! Cohen was due September 2nd and we didn’t have his nursery prepared, we weren’t finished shopping for necessities, and I didn’t have a plan in place for the care of my older son, then three. I learned a LOT about premature babies through my experience and hope to share some of the most important facts and tips when bringing your premature baby home.

A’s and B’s–Apnea and Bradycardia

If you’re the parent of a preemie you have become accustomed to monitors dinging and measures to take when your baby is experiencing apnea or bradycardia. When discharged home, your baby may have a monitor for these things and you can rely on your NICU training on the steps to take when they occur. In our case, a monitor was ordered but not received in time so they sent us home without it. This caused a lot of anxiety for me because he was still having apnea spells. We did a lot of skin to skin and I watched closely to provide stimulation when needed to remind him to breathe. Rest assured your instincts will carry you through until he or she outgrows these spells.

Feeding

Many premature babies go through a lot to learn to suck, breathe, and eat well which could still be a skill he or she is working on when sent home. Breastfeeding in the NICU is difficult due to time restraints, scheduled feedings, monitoring of caloric intake, and your baby’s ability and effort. It takes a lot of energy for a premature baby to eat whether by breast or bottle. It is not impossible to exclusively breastfeed a preemie but requires a lot of support and patience. You will likely be asked to room in with your baby prior to discharge if you plan to exclusively breastfeed so that monitoring of intake, growth, and ability to nurse can be monitored closely. You may be pumping breastmilk and your preemie may be fed breastmilk, breastmilk mixed with fortifier, breastmilk and formula, or solely formula. You can also ask your NICU about donor breastmilk should pumping be difficult for you. Most premature babies are fed a special, high calorie, formula to meet their needs. This formula may be given for days, weeks, or months depending on your baby’s growth.

Medications

It is not uncommon for a premature baby to go home on medications for apnea, bronchopulmonary dysplasia (BPD), reflux, or other medical concerns. You will be given education on administration of these medications and your child will likely be weaned from them in time. Follow up with your pediatrician soon after discharge to ensure your prescriptions can be refilled promptly and to discuss the medication plans. On this note, be sure to learn CPR! Practice as much as possible before bringing your baby home and keep your skills fresh by practicing at home on a baby doll.

Support At Home

This is a toughie! We all need support but with a premature baby, extra visitors increase the risk of illness. Limit the support at home to those that are necessary for your infant’s care which may include one or two family members, a postpartum doula, and therapists involved in your child’s care.

Developmental Concerns

Special clinics are typically available to monitor your child’s development. In addition, you will likely qualify for early intervention services in your home. These services have different names in each state but involve a specialist coming to your home and evaluating your child for services such as occupational therapy, physical therapy, speech therapy, or other specialized areas of concern. Check your state’s requirements but in many states, care is provided to preemies under a certain weight regardless of their developmental delays or lack thereof. My son weighed 1140 grams in Maryland and automatically qualified for services through age three though he met his milestones based on his adjusted age.

Overstimulation

We all know what those “STOP SIGN” hands look like! When your preemie throws his or her hands up near the face with palms spread and appearing to say stop. This is the first sign of overstimulation. Once your baby comes home there are lots of new sights, sounds, and stimulations that can occur. Do your best to minimize these when possible. Organize a quiet, safe space in your home that you and baby can retreat when overstimulation occurs.

Stress

Parents of premature babies are more likely than parents of healthy, full-term babies, to experience postpartum depression and/or post-traumatic stress disorder. Keep a close eye on your emotions and those of your partner and don’t be afraid to reach out to a professional if things don’t appear or feel right. Create a Postpartum Plan to reduce this risk!

Do you have questions about bringing your premature baby home?

Written by: Melissa Nauss, Owner & Lead Doula of Stars and Stripes Doulas of New Orleans

Stars and Stripes Doulas

Stars and Stripes Doulas is honored to be welcomed at many local hospitals and birth centers near military installations throughout the United States. We currently have doulas in Washington DC, Hampton Roads, New Orleans, Fort Riley, and Fort Bragg.